ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT NAME: PHONE FAX
(A/C, No, Ext): (A/C, No): E-MAIL ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT
(Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $
$ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
10/6/2022
License # 0E67768
(619) 574-6223 50203 (619) 574-6288
13056
Gillis & Panichapan Architects, Incorporated
2900 Bristol St. Suite G205
Costa Mesa, CA 92626
25054
A 2,000,000
X X PSB0001119 9/1/2022 9/1/2023 1,000,000
Contractual Liab. 10,000
Serv of Int 2,000,000
4,000,000
4,000,000
Ded 0
A 1,000,000
X X PSA0001116 9/1/2022 9/1/2023
Comp.: $1,000 Coll.: $1,000
A 3,000,000
PSE0001038 9/1/2022 9/1/2023 3,000,000
0 A
X PSW0001177 9/1/2022 9/1/2023 1,000,000
1,000,000
1,000,000
B Prof Liab/Clms Made PRB0619112815 11/8/2021 Per Claim 2,000,000 B Ded.: $5k Per Claim PRB0619112815 11/8/2021 11/8/2022 Aggregate 2,000,000 Re: On call contract
The City of Redondo Beach, its officers, elected and appointed officals, employees and volunteers are Additional Insured with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies to General Liability, Auto Liability and Workers' Compensation.
30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions.
City of Redondo Beach
Public Works Department, Engineering Division
415 Diamond Street
Redondo Beach, CA 90277
GILL&PA-01 MCCOWANA
IOA Insurance Services
4370 La Jolla Village Drive
Suite 600
San Diego, CA 92122
Dana Schwartz
[email protected]
RLI Insurance Company
Hudson Insurance Company
X
11/8/2022
X
X
X
X
X
X
X X
X
X
X
Policy Number: RLI Insurance Company
Named Insured:
PPA 300 03 13 Page 1 of 5
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® BUSINESS AUTO ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A. Broad Form Named Insured
B. Employees As Insureds
C. Blanket Additional Insured
D. Blanket Waiver Of Subrogation
E. Employee Hired Autos
F. Fellow Employee Coverage
G. Auto Loan Lease Gap Coverage
H. Glass Repair – Waiver Of Deductible
I. Personal Effects Coverage
J. Hired Auto Physical Damage Coverage
K. Hired Auto Physical Damage – Loss Of Use
L. Hired Car – Worldwide Coverage
M. Temporary Transportation Expenses
N. Amended Bodily Injury Definition – Mental Anguish
O. Airbag Coverage
P. Amended Insured Contract Definition – Railroad Easement Q. Coverage Extensions – Audio, Visual And Data Electronic Equipment Not Designed Solely For The Production Of Sound
R. Notice Of And Knowledge Of Occurrence
S. Unintentional Errors Or Omissions
T. Towing Coverage
PSA0001116
Gillis + Panichapan Architects, Inc.
PPA 300 03 13 Page 2 of 5
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. Broad Form Named Insured
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured Provision:
Any business entity newly acquired or formed by you
during the policy period, provided you own fifty
percent (50%) or more of the business entity and the
business entity is not separately insured for Bus-iness Auto Coverage. Coverage is extended up to a
maximum of one hundred eighty (180) days following
the acquisition or formation of the business entity.
This provision does not apply to any person or
organization for which coverage is excluded by
endorsement.
B. Employees As Insureds
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured Provision:
Any “employee” of yours is an “insured” while using a
covered “auto” you don't own, hire or borrow in your
business or your personal affairs.
C. Blanket Additional Insured
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured Provision:
Any person or organization that you are required to
include as an additional insured on this coverage form
in a contract or agreement that is executed by you
before the “bodily injury” or “property damage” occurs
is an “insured” for liability coverage, but only for
damages to which this insurance applies and only to
the extent that person or organization qualifies as an
“insured” under the Who Is An Insured provision
contained in SECTION II – COVERED AUTOS
LIABILITY COVERAGE.
The insurance provided to the additional insured will
be on a primary and non-contributory basis to the
additional insured’s own business auto coverage if
you are required to do so in a contract or agreement
that is executed by you before the “bodily injury” or
“property damage” occurs.
D. Blanket Waiver Of Subrogation
The following is added to the SECTION IV – BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5.
Transfer Of Rights Of Recovery Against Others
To Us:
We waive any right of recovery we may have against
any person or organization to the extent required of
you by a contract executed prior to any “accident” or
“loss”, provided that the “accident” or “loss” arises out of the operations contemplated by such contract. The
waiver applies only to the person or organization
designated in such contract.
E. Employee Hired Autos
1. The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE,
Paragraph A.1. Who Is An Insured Provision:
An “employee” of yours is an “insured” while
operating an “auto” hired or rented under a
contract or agreement in that “employee's” name,
with your permission, while performing duties
related to the conduct of your business.
2. Changes In General Conditions:
Paragraph 5.b. of the Other Insurance Condition in the BUSINESS AUTO CONDITIONS is deleted and replaced with the following:
b. For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
“autos” you own:
(1) Any covered “auto” you lease, hire, rent
or borrow; and
(2) Any covered “auto” hired or rented by
your “employee” under a contract in that
individual “employee's” name, with your
permission, while performing duties
related to the conduct of your business.
However, any “auto” that is leased, hired,
rented or borrowed with a driver is not a
covered “auto”.
F. Fellow Employee Coverage
SECTION II – COVERED AUTOS LIABILITY
COVERAGE, Exclusion B.5. does not apply if you
have workers compensation insurance in-force
covering all of your employees.
G. Auto Loan Lease Gap Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE,
C. Limit Of Insurance, is amended by the addition of
the following:
In the event of a total “loss” to a covered “auto” shown in the Schedule of Declarations, we will pay any
unpaid amount due on the lease or loan for a covered
“auto”, less:
1. The amount paid under the PHYSICAL
DAMAGE COVERAGE section of the policy; and
2. Any:
a. Overdue lease/loan payments at the time of
the “loss”;
PPA 300 03 13 Page 3 of 5
b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage.
c. Security deposits not returned by the lessor;
d. Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease;
and
e. Carry-over balances from previous loans or
leases.
H. Glass Repair – Waiver Of Deductible
SECTION III – PHYSICAL DAMAGE COVERAGE,
D. Deductible is amended by adding the following:
No deductible for a covered “auto” will apply to glass
damage if the glass is repaired rather than replaced.
I. Personal Effects Coverage
The following is added to SECTION III – PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
c. Personal Effects Coverage
In the event of a total theft loss of your covered
“auto” we will pay up to $400 for “loss” to wearing
apparel and other personal effects which are:
(1) Owned by an “insured”; and
(2) In or on your covered “auto”;
No deductible applies to Personal Effects
Coverage.
J. Hired Auto Physical Damage Coverage
The following is added to SECTION III – PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
d. Hired Auto Physical Damage Coverage
If hired “autos” are covered “autos” for Liability
Coverage and this policy also provides Physical
Damage Coverage for an owned “auto”, then the
Physical Damage Coverage is extended to
“autos” that you hire, rent or borrow subject to the
following:
(1) The most we will pay for “loss” in any one
“accident” to a hired, rented or borrowed
“auto” is the lesser of:
(a) $60,000
(b) The actual cash value of the damaged or
stolen property as of the time of the
“loss”; or
(c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
(2) An adjustment for depreciation and physical
condition will be made in the event of a total
“loss”.
(3) If a repair or replacement results in better
than like kind or quality, we will not pay for the
betterment.
(4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
auto will apply.
(5) This Coverage Extension will not apply to:
(a) Any “auto” that is hired, rented or
borrowed with a driver; or
(b) Any “auto” that is hired, rented or
borrowed from your “employee”.
K. Hired Auto Physical Damage – Loss Of Use
The following is added to SECTION III – PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
e. We will pay sums which you legally must pay to
the lessor of a covered “auto” which you have
leased without a driver for thirty (30) days or less
for the lessor’s loss of use of the covered “auto”,
provided:
(1) This insurance provides comprehensive,
specified causes of loss or collision covered
on the covered “auto”;
(2) The loss of use results from the covered
“auto” being damaged in an “accident” while
you are leasing it.
We will pay up to a maximum limit of $1,500 for
this covered extension.
L. Hired Car – Worldwide Coverage
The following is added to SECTION II – COVERED
AUTOS LIABILITY COVERAGE, A.2. Coverage
Extensions:
f. Hired Car – Worldwide Coverage
(1) We will pay all sums an “insured” legally must
pay as damages because of “bodily injury” or
“property damage” to which this insurance
applies, caused by an “accident” which
occurs outside of the United States of
America, the territories and possessions of
the United States of America, Puerto Rico
and Canada resulting from the maintenance,
or use of any covered “auto” of the private
passenger type you lease, hire, rent or
borrow without a driver for thirty (30) days or
less.
(2) With respect to any claim made or “suit”
instituted outside the United States of
America, the territories and possessions of
the United States of America, Puerto Rico,
and Canada:
PPA 300 03 13 Page 4 of 5
(a) You shall undertake the investigation,
settlement and defense of such claims
and “suits” and keep us advised of all
proceedings and actions.
(b) You will not make any settlement without
our consent.
(c) We will reimburse you:
(i) For the amount of damages because of liability imposed upon you by law on account of “bodily injury” or
“property damage” to which this
insurance applies, and
(ii) For all reasonable expenses incurred
with our consent in connection with
the investigation, settlement or
defense of such claims or “suits”.
Reimbursement for expenses will be
part of the Limit of Insurance for
liability coverage shown in the
Business Auto Coverage
Declarations, and not in addition to
such limits.
(3) The limit of Insurance for Liability Coverage
shown in the Business Auto Coverage
Declarations is the most we will reimburse
you for the sum of all damages imposed on
you, as set forth in paragraph 2.c. above, and
all expenses incurred by you arising out of
any single “accident” or “loss”.
(4) You must maintain the greater of the following primary auto liability insurance limits:
(a) Compulsory admitted insurance with
limits required to be in force to satisfy the
legal requirements of the jurisdiction
where the accident occurs; or
(b) Insurance limits required by law and
issued by a government entity or by an
insurer licensed or permitted by law to do
business in the jurisdiction where the
“accident” occurs; or
(c) Auto liability insurance limits of at least
$300,000 combined single limit or
$100,000 per person/$300,000 per accident Bodily Injury, $100,000 Property Damage.
If you fail to comply with the above, this
insurance is not invalidated. However, in the
event of a “loss”, we will pay only to the extent
that we would have been liable had you so
complied.
(5) The insurance provided by this coverage
extension is excess over any other collectible insurance available to you whether on a primary, excess contingent or any other
basis.
M. Temporary Transportation Expenses
SECTION III – PHYSICAL DAMAGE COVERAGE,
A.4. Coverage Extensions, subparagraph a.
Transportation Expenses is deleted and replaced
by the following:
a. Transportation Expenses
(1) We will pay up to a maximum of $1,500 for
temporary transportation expense incurred
by you because of Physical Damage to a
covered “auto”.
(2) We will pay only for those covered “autos” for
which you carry Comprehensive, Colli-sion or
Specified Case of Loss Coverage.
(3) We will pay only for those expenses incurred
by you during the period of time that begins
twenty-four (24) hours after the covered
“loss” and ends at the time when the covered
“auto” can be reasonable repaired or
replaced.
(4) This coverage does not apply while there are
spare or reserve “autos” available to you for
your operations.
N. Amended Bodily Injury Definition – Mental
Anguish
The following is added to SECTION V –
DEFINITIONS, Definition C.:
“Bodily injury” also includes mental anguish, but only
when the mental anguish arises from other bodily
injury, sickness or disease.
O. Airbag Coverage
The following is added to SECTION III – PHYSICAL
DAMAGE COVERAGE B. Exclusions 3.a.:
However, this exclusion will not apply to accidental
discharge of an airbag due to mechanical or electrical
breakdown.
P. Amended Insured Contract Definition – Railroad
Easement
SECTION V – DEFINITIONS paragraph H. “Insured
contact” is modified as follows:
1. Paragraph H.3. is replaced by the following:
3. Any easement or license agreement.
2. Paragraph H.6.a. is deleted.
Q. Coverage Extensions – Audio, Visual And Data
Electronic Equipment Not Designed Solely For
The Production Of Sound
SECTION III – PHYSICAL DAMAGE COVERAGE B.
Exclusions, exception paragraph a. to exclusion 4.c.
and 4.d. is deleted and replaced with the following:
PPA 300 03 13 Page 5 of 5
a. Equipment and accessories used with such
equipment, except for tapes, records, discs or
other electronic media device, provided such
equipment is permanently installed in the covered
“auto” at the time of the “loss” or is removable
from the housing unit which is permanently
installed in the covered “auto” at the time of the
“loss”, and such equipment is designed to be
solely operated by use of the power from the
“autos” electrical system, in or upon the covered
“autos”; or
R. Notice Of And Knowledge Of Occurrence
SECTION IV – BUSINESS AUTO CONDITIONS,
A.2. Duties In The Event Of Accident, Claim Suit
Or Loss, subparagraph a. is deleted and replaced
with the following:
a. In the event of “accident”, claim, “suit” or “loss”, you must give us or our authorized representative prompt notice of the “accident” or “loss” including:
(1) How, when and where the “accident” or “loss”
occurred;
(2) The “insured’s” name and address; and
(3) To the extent possible, the names and
addresses of any injured person and
witnesses.
Your duty to give us or our authorized
representative prompt notice of the “accident” or
“loss” applies only when the “accident” or “loss” is
known to:
(1) You, if you are an individual;
(2) A partner if you are a partnership; or
(3) An executive officer or insurance manager, if
you are a corporation.
S. Unintentional Errors Or Omissions
SECTION IV – BUSINESS AUTO CONDITIONS, B.
General Conditions; 2. Concealment Misrepresentation Or Fraud is amended by adding the following:
The unintentional omission of, or unintentional error
in, any information given by you shall not prejudice
your rights under this insurance. However this provision does not affect our right to collect additional premium or exercise our right of cancellation or
nonrenewal.
T. Towing Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE,
A.2. Towing, is deleted and replaced by the
following:
2. We will pay up to $750 for towing and labor costs
incurred each time a covered “auto” is disabled
due to a covered cause of loss. However:
a. All labor must be performed at the place of
disablement; and
b. If the covered auto is a private passenger
type no deductible applies; and
c. If the covered auto is not of the private
passenger type our obligation to pay will be
reduced by a $250 deductible per
disablement.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.